What is Exercise Physiology and is it for me?
Recovawear talks to Melbourne-based Exercise Physiologist Elizabeth Hewett about Exercise Physiology, and learns what sets it apart as a movement therapy.
What is Exercise Physiology?
Exercise Physiology relies on the principle that exercise can be used as medicine. Exercise has been shown to speed recovery, prevent injury and promote improved health and wellness for a range of diseases and conditions, including osteoporosis, diabetes, and depression. Exercise Physiology can also be used for fitness conditioning for athletes.
Exercise has been known to be beneficial to health since the time of Hippocrates. It has been promoted in 16th century texts, and by the 19th century the deleterious effects of too little exercise, such as poor circulation or a depressed immune system, were becoming known. The first Exercise Physiology textbook was published in 1910, and throughout the 20th century laboratories were devoted to the study of exercise as medicine.
Exercise is a specific type of physical activity with set and measurable goals such as improving strength, fitness, or flexibility. This is distinct from physical activity which involves any daily activity that involves muscle contraction, for example, shopping or gardening.
Give us a brief CV Elizabeth Hewett.
“I am an accredited Exercise Physiologist, a Clinical Pilates instructor and have a Cert IV in Training and Assessment. I have a background in dance, and worked for eight years at the Australian Ballet School, training students between the ages of eight and 22. I have written and collaborated on peer-reviewed journal articles, taught workshops and in 2017 I launched my own business seeing clients in Exercise Physiology, Clinical Pilates, and teaching professional development courses in both these areas.”
What happens in the first session at an Exercise Physio?
“The number one thing I do when I first see a client is establish their beliefs and their experiences and their relationship with movement - because that’s key to engaging somebody with the possibility of using exercise as part of their preparation and recovery from surgery. Maybe because they’ve tried and they’ve failed, or they’ve failed in their eyes, or they got injured or had a bad experience, they are thinking ‘it doesn’t work for me’ or ‘that was back 20 years ago when I was fit and healthy but now I have kids and I don’t have time’."
“Then the next major phase is trying to see where they’re at with introducing or reintroducing movement that will help them and be compatible with their attitudes about putting movement into their life – so that classic behaviour change spectrum. Are they aware of it? Are they interested in it? They may be aware but not interested."
“I say ‘I can give you an exercise program to help you get strong, to cope with your breast cancer, hip surgery or chronic back pain, but it may reinforce bad experiences that you’ve had with a PT 10 years ago, or bullying at school.’ I try to unpack it in a sensitive way when I first meet people, so in actual fact I don’t give people an exercise program in their first session. It’s an information-gathering session and I said to a lady this morning ‘I need to put my detective hat on to work out what’s going on with the muscles around your hip and your posture to see if it's biomechanics or something else.’”
“So my first step - and a good detailed practitioner does this, but it takes time - is a good hour and a quarter initial consultation."
"This in-depth information gathering session about their lifestyle, their work history, their injury history, their past participation in physical activity, whether that be sport, walking years ago right up to present time - that’s part of me gathering their positive and negative experiences and beliefs around movement.”
“Then we work out what sort of environment will they feel comfortable moving or exercising in, is it home or is it a group environment do they prefer to be on their own – so ‘I’ll do one on one’, or ‘I don’t like noisy environments so I want a home program’. Establishing that is very important, because otherwise it’s a mismatch and I’ll give the wrong advice to them.”
Then what happens?
“And then we work out a plan. ‘Ok ,you want to exercise at home, let’s develop a home plan for you that’s actually practical for you, 'cause you’ve got a three-year-old and a dog and a husband who works from home’. So then we have a logistical discussion around what’s practical.”
“So the plan is working out where they will do their new movement pattern – and I use the word 'movement' deliberately, as it’s usually non-threatening, and exercise by definition is a structured, formal goal-oriented progression of moving. Physical activity is unstructured, can be random and unplanned, just muscle contraction e.g. doing the shopping.”
“And for some people just getting them to do more physical activity is what I prescribe for them. Just getting them moving to help their physical condition, walking more, just to get them moving in a way that will help their condition or their mental health or whatever they’re seeing me for. With that plan will be ‘How often do they need to see me?' ‘Is it going to be a regular supervised PT environment at the studio or is it less often than that?’ etc.”
How do clients find you?
“Most of my referrals are word of mouth through a previous or current client, so they book in directly with me, or it’s a referral by their doctor.”
What’s the difference between an exercise physiologist and a physiotherapist?
“An exercise physiologist – we are university qualified allied health professionals who use exercise as a medicine to help people who have chronic health conditions and injury rehab requirements. We ONLY use movement and exercise to help people.”
“A Physio is also a university qualified allied health professional with SOME training in exercise to rehabilitate and manage injury and pain, but they also learn lots of other things like manual therapy techniques, mobilisation, massage, so exercise is just one of their many skills that they have. Often an acute injury lends itself to Physio, while anything more chronic might benefit more from exercise physiology.”
“A good example is a case study – if you break your arm in a snowboarding accident – you will have surgery and you will need Physio in hospital just to get that arm moving again and you may need ongoing Physio or Osteo to make sure the joint is functional and you have a healthy balance of muscles in that initial stage of recovery.”
“But if you want to condition your whole body, while that arm is still recovering – ‘can I ride the bike, can I get my legs strong again, or look after any other fitness or injury needs WHILE respecting that arm protocol’, you will see an Exercise Physio - because we know how to look after injuries and include rehabilitation in overall fitness training.”
“So there is an overlap between Physios and EP’s. How much exercise a Physio does depends on their training and their interest in it. Some Physios do lots of exercise and have done lots of strength and conditioning, so they are closer to EPs. Other Physios though don’t do any exercise at all and just do the hands-on mobilising, taping, strapping, manipulation and then will be very happy for the patient to see me for their exercise.”
“Physio treatments are more targeted and specific too. For example, if you’ve got a sore knee you see a Physio for just that injury, but for an EP client, all of their injury background is taken into account. For example their older ankle injury has made their hip weak, and they have a sore shoulder because they sit at a desk all day, and now they have a knee injury – how do we incorporate all the niggles?”
“Physios choose whether to add exercise in, where for EPs it is their whole practice.”
“The other example is a personal trainer – they get trained very well in how to keep people safe and work around injuries, whereas an Exercise Physio will work very comfortably when someone is injured and know how to take their rehab requirements and integrate it into the body’s fitness training.”
Whether its post-operative rehab, or to look after chronic conditions, Exercise Physiology has great potential to improve patient outcomes. Recovawear recommends, as with all forms of movement therapy, that patients wear easy access, post surgical adaptive clothing, which includes everything from post knee surgery pants that can accommodate a knee brace, to tops for shoulder surgery. We've made sure that adaptable clothing for men and women no longer has to be unsightly – Recovawear may be a bit biased, but we think post surgery clothing has come a long way in the style stakes…which means you can wear your rehab pants and adaptive tops long after your procedure, and well into your chosen movement therapies and beyond.